NEOPLASIA

Dr. A. Kabir
Department of Human Pathology, College of
Medical sciences, UNIMAID

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INTRODUCTION
 Neoplasia literally means the process of new growth
 A neoplasm is a new growth
 Tumour means swelling
 Originally applied to swelling in inflammation
 Tumour now synonymous with neoplasm

 Oncology is scientific study of tumours/ neoplasms

 Cancer is idiomatic term for malignant neoplasms

 Derived from Latin word for crab due to infiltrative
behaviour
 Most concise definition is that of Rupert Willis, a British
Oncologist
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Intro cont’d
 “A neoplasm is an abnormal mass of tissues, the growth of
which exceeds and is uncoordinated with that of the
normal tissues and persists, in the same excessive manner
after cessation of the stimuli which evoked the change”

 The persistence is due to heritable genetic alterations

passed down to progeny of tumour cells
 The genetic changes allow excessive & unregulated
proliferation that becomes autonomous (independent of
physiologic growth stimuli)

 The entire number of cells in a tumour arises from a single

cell that has developed genetic change, i.e they are clonal
 They are formed by autonomous clonal expansion of
abnormal cells which have a selective growth advantage
over neighbouring cells
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Intro cont’d
Tumour can be benign or malignant and are
made up of two basic components:
1. Parenchyma: the proliferating neoplastic
cells.
2. Supportive stroma: made up of connective
tissue and blood vessels.
 Growth & evolution of neoplasms and
critically dependent on both stromal &
parenchymal components.

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NOMENCLATURE
 Based on cell of origin & biologic behaviour
 Divided into Benign & Malignant

BENIGN
 Usually designated by attaching suffix –oma to cell of
origin
 For mesenchymal cells examples include;
 Fibroma – fibroblastic origin
 Chondroma – cartilaginous origin
 Osteoma – osteoblastic origin

 For epithelial cells is more complex

 Based on cell of origin, microscopic architecture,
macroscopic pattern
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Nomenclature cont’d
 Papilloma –tumour raised above an epithelial surface and
forms finger-like projections e.g squamous, transitional

 Adenoma-tumour forming glandular structures or

arising from parenchyma organs

 Cystadenoma-forming glands & cystic spaces e.g ovary

 Papillary cystadenoma-above with papillary formation

 Nevus-benign tumour of melanocytes (in the skin)

 Trophoblastic tumour –hydatidiform mole (placenta)

 Polyps are lesions that produce a macroscopic visible

projection above a mucosal surface & into a lumen e.g
colon, bladder 6
Nomenclature cont’d
MALIGNANT
 Similar scheme for benign neoplasms
 Carcinoma are malignant neoplasm of epithelial
origin, from any of the 3 germ layers
 May be further qualified e.g
 Adenocarcinoma when a glandular pattern is
observed
 Squamous cell carcinoma when it produces
recognizable squamous cells in any epithelium
 Transitional cell carcinoma when it forms transitional
cells

 Sarcomas are malignant neoplasms arising in

mesenchymal tissue (sar = fleshy) due to scant
connective tissue
E.g Fibrosarcoma (fibroblast), Liposarcoma –fat cells
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
Nomenclature cont’d
 Leiomyosarcoma –smooth muscle
 Rhabdomyosarcoma – differentiate towards skeletal
muscle
 Blastomas -are malignant tumours of embryonic
origin usually seen in children e.g retinoblastoma

MIXED TUMOURS
 When there is divergent differentiation of a single
line of parenchymal cells e.g
 1. Pleomorphic adenoma of salivary glands
 composed of epithelial components within a myxoid
stroma, islands cells
 2. Fibroadenoma of breast with epithelial ducts &
stroma 8
Nomenclature cont’d
 TERATOMA
 Composed of a variety of parenchymal cell types
representative of more than one germ layer, usually all
3- ecto, meso & endoderm
 Arise from totipotential cells which differentiate along
germ lines producing skin, muscle, fat, gut epithelium,
teeth, bone e.t.c
 E.g ovarian cystic teratoma (dermoid cyst) which
differentiates along ectodermal lines

 Certain EXEMPTIONS TO CONVENTIONAL NOMENCLATURE

 E.g melanoma, myeloma, seminoma, lymphoma,
hepatoma which are all malignant, others e.g haematoma
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Nomenclature cont’d
 CHORISTOMA
 Ectopic rest of normal tissues e.g
 Rest of adrenal cells under kidney capsule
 Pancreatic nodular rest in small intestinal mucosa or Meckels
diverticulum

 HAMARTOMA
 Totally benign
 Mass of disorganized but mature specialized cells or tissue
indigenous to the particular site e.g
 Lung hamartoma composed of islands of cartilage, blood
vessels, bronchial type structures, & lymphoid tissue
 Haemangioma composed of proliferating blood vessels in a
disorganized fashion

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Gross morphology of Polyp

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Photomicrograph of Polyp

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Papilloma

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Characteristics of malignant cells
 Histologically, the characteristics of
malignant cells are:
 Pleomorphism
 Hyperchromatism
 Increased nucleocytoplasmic ratio
 Coarsely clumped chromatin
 Large, multiple, prominent nucleoli
 Numerous, bizarre mitoses
 Presence of tumours giant cells
 Disorderliness or markedly disturbed
orientation

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Local invasion
 Most benign tumours are encapsulated
 Malignant tumours grow to progressively
invade surrounding tissue, thus invasiveness
is a feature of malignancy
 Invasion starts from penetration of the
basement membrane to involve the stroma

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Metastasis
 This refers to tumour implants found distant from the
primary tumour.
 It is an important hallmark of malignancy.

 Metastasis occurs through (routes):

 Blood vessel
 Lymphatics
 Body cavities-peritoneum, pleural, joint, pericardial,

subarachnoid space

 Common sites of metastasis: lung, liver, bone, brain

 Aggressiveness, rapid growth and large size are features

that increase metastatic potential.
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Differentiation
 Defined as the extent to which parenchyma
cells of tumours resemble comparable normal
cells-(well, moderate, poorly differentiation).

 Undifferentiated tumours are anaplastic i.e

lack of differentiation
 Anaplasia [reversion from high to low level of
differentiation] is the hall mark of malignant
transformation histologically.

 Used in histologic tumour grading

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Epidemiology of cancer
 This relates to occurrence of cancer to certain
environmental, cultural or racial factors thus
giving an insight into the aetiology,

 Factors that influence incidence of malignant

tumours include;
 Geographic and environmental.
 AGE
 Heredity.

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Geographic/environmental factor
 Racial
 Temperature/climate
 Occupational hazards
 Habits-diet, smoking, alcohol abuse
 Sexual practices
 Obesity.

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Heredity in cancer incidence
 [a] Inherited cancer syndrome- Autosomal
Dominant e.g. retinoblastoma, familial
adenomatous polyposis, neurofibromatosis,
MEN syndrome.

 [b] Familial cancers-no specific marker,

transmission pattern not clear e.g Breast,
colon, ovary, brain.

 [c]Autosomal recessive syndromes of defective

DNA repair e.g Ataxia telangiectasia,
Xeroderma pigmentosum, Bloom syndrome,
Fanconi anemia.
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Pre-neoplastic lesions
 Bronchial dysplasiacarcinoma of the
bronchus
 Dysplastic squamous papillomaSCC
 Chronic atrophic gastritisGastric carcinoma
 Chronic ulcerative colitiscolonic cancer
 Villous adenoma of the coloncolonic cancer
 Cervical dysplasia SCC of the cervix
 Complex endometrial

hyperplasia.endometrial carcinoma
 Liver cirrhosis hepatocellular carcinoma
 Solar keratosis-skin dysplasiaSCC of the

skin 36
Carcinogenesis
 Refers to the process of malignant
transformation of normal cells by carcinogenic
agents (including physical, chemical and
microbiologic agents).

 Carcinogenic agents are classified into:

 -physical, e.g. ionizing radiation, X-ray,
radiotherapy, Ultraviolet light, atomic energy

 -chemical, e.g. alkylating agents, Nitrosamine,

Benz pyrene

 -microbiologic-viruses; HPV, EBV, hepatitis B& C

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Effects of malignant tumour on the
host
 Local pressure effects e.g pituitary adenoma
 Functional activity e.g insulinoma
 Haemorrhage
 Secondary infection
 Infarction/rupture
 Cancer cachexia-due to effect of cytokines
(Wt. Loss+anaemia+ anorexia+ weakness)
 Paraneoplastic syndrome

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Paraneoplastic syndrome
 symptom complex in cancer-bearing patient
that cannot be explained by local/distant
spread of the tumour.

 Importance of paraneoplastic syndrome are:

◦ They may represent the earliest manifestation of an
occult malignancy
◦ May represent a significant clinical problems that
may be lethal
◦ May mimic metastatic disease and therefore
complicate clinical management

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Grading and staging of tumours
 Grading: Refers to level of microscopic resemblance of
tumour cells to normal similar cell of origin
 Level of differentiation correlates with aggressiveness.
 Well diff. Tumour closely resembles cell of origin while
poorly diff. Tumour do not have any resemblance.
 Various grading systems are available and differ with
different tumours

 Staging: Refers to extent of tumour spread.

.Based on size of primary tumour,+/-lymph node,+/-
distant blood borne metastasis.
 TNM —> I-IV

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Common cancers
 Common cancers  common childhood
(both males and cancers
females together )  Burkitt lymphoma
 breast  retinoblastoma
 cervix  nephroblastoma
 prostate  Sarcomas
 Liver  Leukaemias
 colorectal  Neuroblastomas

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Laboratory diagnosis of tumour
 Histology- paraffin/frozen section

 Cytology-FNAC, pap smear, effusions

 Immunocytochemistry and
immunohistochemistry - monoclonal antibodies

 Molecular –oncogenes

 Tumour markers
 ETC

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